The Hmong Women’s Heritage Association (HWHA), in collaboration with the American Cancer Society (ACS), California Dialogue On Cancer (CDOC), Creating Healthier Communities Diversity Coalition of Greater Sacramento, National Cancer Institute’s Cancer Information Service, and the Asian American Network for Cancer Awareness Research and Training (AANCART), held a community discussion on Saturday, January 23, 2010 at the Kaiser Permanente Medical Center, South Sacramento. Entitled Cancer Care for Hmong Americans: A Community Discussion, the goal of the community discussion was to engage the local Hmong community in raising awareness and identifying barriers to cancer screening, early detection, and treatment. About 30 individuals from the Hmong community, 23 staff from the collaborating organizations, and 6 volunteers attended the event.
Dr. Nhia Kash Vang, M.D. was the first guest speaker. He presented on Cancer 101 & Before Diagnosis: Screening Guidelines. A clinical practitioner at the Oroville Hospital, Dr. Vang is currently the health consultant for the Hmong Cultural Center of Butte County. He was also guest speaker to a number of presentations on various health issues for the Hmong community in Oroville. After his presentation, a group discussion followed to identify and barriers on cancer screening and to recommend steps on overcoming these barriers.
The second guest speaker was Dr. Helen K. Chew, M.D. who presented on After Diagnosis: Cancer referral process, cancer treatment options, and clarifying many misconceptions of cancer treatment. Currently, Dr. Chew is an Associate Professor of Internal Medicine at the University of California in Davis and Director of the Clinical Breast Cancer Program at the UC Davis Cancer Center. Her presentation was followed by open discussion and networking.
Both guest speakers received positive feedbacks from the audience. These feedbacks were reflected on the evaluation forms that were distributed and collected at the end of the event. Group DiscussionBelow are the five sets of questions for participants who joined the group discussions and responded to the questions.
1. In your opinion, what are the barriers for the Hmong (like yourselves) in receiving screening for cancer?
(a) Fears: Some participants said they are fearful of doctors and suspicious of people being test-subjects. They are fearful of knowing the result from screen tests. Treatment does not guarantee cure. Invasive surgery can be traumatic and knowing the result of screen tests may only lead to more stress which may lead to more illness.
(b) Education: Participants said they lack the knowledge of screening tools and do not know what questions to ask. Lack of understanding about the importance and benefits of screening tests. Others also suggested the need to educate Hmong men about screening test.
(c) Service Access: There is a lack of transportation to and from treatment centers. They cannot understand medical language – e.g. confused on the concept of cell. Many are uninsured and cannot afford to pay for screening test.
(d) Doctors: Either they have no confidence or lack trust in physicians. Primary physician does not inform patients about the dangers of cancers. Doctors tentative language, like “probable” or “not guaranteed,” is not clear to them and creates more fear and stress.
(e) Culture and Traditional Healing: Some feel they are fine and do not need to see a doctor, so they engage in “one-time, “quick fix” solutions. Their husbands are not supportive of their wives taking screen tests. Men and husbands make health decisions for the girls and women in the family. Some believe spiritual healing may actually help cure cancer.
(f) Personal: Denial is a health problem, but they feel obligated to follow through with doctor’s recommendation. Screening test is time consuming, but no one is home to take care of the children. Hmongs have a strong belief on personal privacy. Exposing their body parts to strangers like doctors can be a barrier.
2. How can we overcome these barriers?
(a) Through Education: There is a need to promote awareness on screening and treatment. Resources to health care access should be available. Health promotion on screening and treatment through community education, health forums and conferences tailored for Hmong community may reach wider participation and heighten knowledge and awareness. Dissemination of screening and treatment information through Hmong radio and television programs are effective tools for outreach. One-on-one home education was also recommended. Participants believed that educating the men in the family and requiring their participation are important.
(b) Ways to Access Service: Provide accessible transportation and competent interpreters.
(c) Reform Healthcare: There was a recommendation to trust Hmong alternative healing while looking up to western medicine.
(d) Increase culturally competent service providers: Hire more qualified Hmong staff or culturally competent personnel. Identify physicians who have worked with Hmong population and local doctors who can provide screening and treatment education. Establishing trust is essential in building relationship with the Hmong community, and one way to achieving this is to ask doctors the importance of listening to Hmong patient’s opinion and beliefs regarding cancer.
3. In your opinion, what needs to be done to help more Hmong (like yourselves) to get a cancer screening test?
(a) Outreach: Utilize radio stations, PSA’s, television advertising that Hmong community has access to. Sponsor more forums and conferences. Organize community events like walk for cancer and invite cancer patients in community events for testimony.
(b) Education: Train and hire younger Hmong individuals to become health educators. They can foster confidence and trust among the community and encourage parents to get screening test. Educate Hmong men on the benefits of screening, early detection, and treatment. Consider western medicine as an ally to cancer detection. Finally, publish or create a journal that discusses cancer topics.
(c) Cultural Competent Physicians: Build trust with the Hmong community.
(d) Service access: Provide direct transportation to and from screening locations or organize mobile screening tests to reach out to the community.
(e) Personal: Do not be afraid to ask for help. Ask physicians questions about cancer and put embarrassment aside.
4. What activities should be carried out? What do you think doctors could do? What do you think the government could do? What do you think HWHA could do?
(a) Doctors: Foster good relationship and trust with patients. Involved Hmong doctors to participate in outreach efforts. Utilization of visual aids and photographs can be an effective approach when informing patients. There is a need for doctors to spend more time helping patients understand the various signs and symptoms of cancer.
(b) Government: Provide more funding for cancer education and screening. Create database for specific API groups.
(c) HWHA: Find more grant for cancer education and do its own fundraising events. Organize more community events and partner with other agencies to continue raising awareness. Coordinate interpreters, transportation and screening test program. Create a link to cancer news on HWHA website. Help provide information on the health status and well being of Hmong community among various agencies and stakeholders.
(d) Cancer Survivors: Create venues, opportunities, events, and activities where they can tell their stories to the community.
5.Who should be responsible for these activities? What do you think families could do? What do you think you can do?
(a) Government: MediCAL should cover the insurance and help fund more language specific cancer programs .
(b) Competent Individuals and Organizations: Encourage Hmong community leaders to become health educators and advocates themselves. Since the community look up to them, they can be effective health advocates on behalf of the community. They can serve as key leaders to educate Hmong families.
(d) Yourself: There is a need to self-education and utilize it to educate others in returen. Individuals can provide moral and emotional support and can help refer community members to access resources for screening test, early detection, and treatment services.Evaluation Results
Both guest speakers received positive feedbacks from participants. The other five evaluation questions received positive feedbacks as well. Overall, the evaluation feedbacks that follow below illustrate the success of the Community Discussion:
1. Dr. Nhia Vang was knowledgeable in providing information on Cancer 101 and Before Diagnosis Screening: 78% (29/37) agreed.
2. Dr. Helen Chew was knowledgeable in providing information on After Diagnosis Treatment: 89% (33/37) agreed.
3. I have a better understanding of what cancer is:70% (26/37) agreed.
4. I have a better understanding of the different types of cancer treatments available:57% (21/37) agreed.
5. I am more aware of the high risk cancers in the Hmong community:66% (25/38) agreed.
6. After participating in this conference, I am more likely to ask my doctor for a preventative screening test:76% (29/38) agreed.

After participating in this conference, I am more willing to talk to my doctor about cancer screening and treatment:

71% (27/38) agreed.

Summary

The success of Cancer Care for Hmong Americans: A Community Discussion, started from the beginning when the various organizations came and decided to hold this event. The event was well organized and right on with its target audience – the Hmong community. Feedbacks from the discussion groups provided organizers with clear direction and actions to be taken in the near future. The response from the evaluation questions were encouraging. Having two guest speakers who were knowledgeable about cancer in the Hmong community lent this event culturally appropriate and relevant. The invaluable expertise and knowledge of Dr. Vang and Dr. Chew contributed to the heightened awareness of participants. The majority of them are now more aware about the needs for screening, early detection, treatment, and addressing barriers. They also indicated the willingness to help spread this awareness. The success of a community event such as the Cancer Care for Hmong Americans: A Community Discussion depended on the collective efforts of everyone involved. In this case event organizers have done their job to make it a rewarding experience from which to draw lessons for future ones. Finally, the success of this community discussion should be shared to a broader audience so that others may learn from it.